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Platelet reactivity inhibition following ticagrelor-loading dose in patients undergoing percutaneous coronary intervention for acute coronary syndrome
Archives of Cardiovascular Disease Supplements (2020) 12, 5—27
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ScienceDirect www.sciencedirect.com
01—Coronary heart disease Thursday, January 16th, 2020 016
Platelet reactivity inhibition following ticagrelor-loading dose in patients undergoing percutaneous coronary intervention for acute coronary syndrome V. Panagides 1,∗ , M. Laine 1 , C. Frere 2 , T. Cuisset 3 , C. Gouarne 1 , B. Jouve 4 , F. Thuny 1 , F. Paganelli 1 , M.C. Alessi 5 , J. Mancini 6 , L. Bonello 1 1 Cardiologie, Hôpital Nord, Marseille 2 Haematologie, AP—HP, Pitié-Salpêtrière, Paris 3 Hôpital de la Timone, Marseille 4 Centre Hôspitalier d’Aix-En-Provence, Aix-En-Provence 5 Centre de recherche en nutrition et maladies cardiovasculaires 6 Département de bio-statistiques, Assistance publique des hôpitaux de Marseille, Marseille, France ∗ Corresponding author. Adresse e-mail : [email protected] (V. Panagides) Background Ticagrelor induces more potent platelet reactivity (PR) inhibition with reduced interindividual variability compared to clopidogrel. Although on-clopidogrel PR was shown to correlate with ischemia and bleeding events, data regarding PR from ticagrelor and the outcomes are lacking. Purpose We aimed to determine the association between PR after a ticagrelor loading dose (LD), assessed by the vasodilatorstimulated phosphoprotein index (VASP), and thrombotic and bleeding events in patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI). Methods We performed a prospective, multicenter observational study on patients treated with PCI for ACS. The VASP index was used to assess PR after ticagrelor LD. The primary endpoint was the link between major adverse cardiovascular events (MACE) and PR. Results Among the included 530 patients with ACS, 185 (34.5%) were admitted for ST elevation myocardial infarction. We observed high potency and limited interindividual variability after the ticagrelor LD (VASP 19.1 ± 16.6%). At 1 month, 21 (3.8%) MACE and 29 (5.5%) bleedings Academic Research Consortium ≥ 2 events were recorded. Neither MACE nor bleeding were associated with PR (P = 0.34and p = 0.78 respectively). However, there was a strong association between PR and the occurrence of definite acute stent thrombosis (P = 0.03). PR was the only factor associated with acute definite stent thrombosis.
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Conclusion In patients receiving a ticagrelor LD while undergoing PCI for ACS, PR using the VASP does not predict MACE or bleeding, but it is significantly associated with the occurrence of definite acute ST. Disclosure of interest This study was funded by a research grant from AstraZeneca. https://doi.org/10.1016/j.acvdsp.2019.09.002 053
Progression in cerebral microbleeds number after acute myocardial infarction: Harmful role of triple antithrombotic therapy H. Debeaumarche 1 , A. Alaa El Din 1 , P. Thouant 2 , M. Maza 1 , F. Ricolfi 2 , M. Zeller 3,∗ , F. Bichat 1 , N. Baudoin 2 , Y. Béjot 4 , Y. Cottin 1 1 Service de cardiologie 2 Service de neuroradiologie, CHU Dijon-Bourgogne 3 PEC2, EA 7460, UFR Sciences de Santé, Université Bourgogne Franche-Comté 4 Service de Neurologie, CHU Dijon-Bourgogne, Dijon, France ∗ Corresponding author. Adresse e-mail : [email protected] (M. Zeller) Introduction Cerebral microbleeds (CMB) is a predictive factor of intracerebral haemorrhage (ICH) and patients with CMB under antithrombotics are at higher risk of ICH. Thus, the impact of anticoagulants and/or antiplatelets on the occurrence of ICH and/or on new CMB development is a major issue. Purpose We aimed to evaluate the early progression at 3 months of CMB and their predictive factors in patients with acute myocardial infarction (AMI) treated with direct oral anticoagulant (DOA) or vitamin K antagonist (VKA). Methods Prospective study from November 2016 to December 2018, including patients > 60 y hospitalized in intensive cardiac care unit for AMI. They underwent a first brain MRI (T2* gradient echo and SWI magnetic susceptibility image) < 72 hours after admission, and repeated 3 months after stenting. Results One hundred and eight patients (42 women and 66 men, mean age 77 years) were included. Among the patients with CMB (21%), 66 patients received a cerebral MRI at 3 months after AMI. An increase in CMB number was observed for 6% of patients. These patients were older than those without CMB progression (85 ± 5 vs. 75 ± 8 y, P = 0.016) and were more often treated by DOA or VKA at hospital discharge than patients with unchanged CMB number:OR = 15.6 [1.470—165.582]. In multivariate analysis, only
Available online at
ScienceDirect www.sciencedirect.com
01—Coronary heart disease Thursday, January 16th, 2020 016
Platelet reactivity inhibition following ticagrelor-loading dose in patients undergoing percutaneous coronary intervention for acute coronary syndrome V. Panagides 1,∗ , M. Laine 1 , C. Frere 2 , T. Cuisset 3 , C. Gouarne 1 , B. Jouve 4 , F. Thuny 1 , F. Paganelli 1 , M.C. Alessi 5 , J. Mancini 6 , L. Bonello 1 1 Cardiologie, Hôpital Nord, Marseille 2 Haematologie, AP—HP, Pitié-Salpêtrière, Paris 3 Hôpital de la Timone, Marseille 4 Centre Hôspitalier d’Aix-En-Provence, Aix-En-Provence 5 Centre de recherche en nutrition et maladies cardiovasculaires 6 Département de bio-statistiques, Assistance publique des hôpitaux de Marseille, Marseille, France ∗ Corresponding author. Adresse e-mail : [email protected] (V. Panagides) Background Ticagrelor induces more potent platelet reactivity (PR) inhibition with reduced interindividual variability compared to clopidogrel. Although on-clopidogrel PR was shown to correlate with ischemia and bleeding events, data regarding PR from ticagrelor and the outcomes are lacking. Purpose We aimed to determine the association between PR after a ticagrelor loading dose (LD), assessed by the vasodilatorstimulated phosphoprotein index (VASP), and thrombotic and bleeding events in patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI). Methods We performed a prospective, multicenter observational study on patients treated with PCI for ACS. The VASP index was used to assess PR after ticagrelor LD. The primary endpoint was the link between major adverse cardiovascular events (MACE) and PR. Results Among the included 530 patients with ACS, 185 (34.5%) were admitted for ST elevation myocardial infarction. We observed high potency and limited interindividual variability after the ticagrelor LD (VASP 19.1 ± 16.6%). At 1 month, 21 (3.8%) MACE and 29 (5.5%) bleedings Academic Research Consortium ≥ 2 events were recorded. Neither MACE nor bleeding were associated with PR (P = 0.34and p = 0.78 respectively). However, there was a strong association between PR and the occurrence of definite acute stent thrombosis (P = 0.03). PR was the only factor associated with acute definite stent thrombosis.
1878-6480/
Conclusion In patients receiving a ticagrelor LD while undergoing PCI for ACS, PR using the VASP does not predict MACE or bleeding, but it is significantly associated with the occurrence of definite acute ST. Disclosure of interest This study was funded by a research grant from AstraZeneca. https://doi.org/10.1016/j.acvdsp.2019.09.002 053
Progression in cerebral microbleeds number after acute myocardial infarction: Harmful role of triple antithrombotic therapy H. Debeaumarche 1 , A. Alaa El Din 1 , P. Thouant 2 , M. Maza 1 , F. Ricolfi 2 , M. Zeller 3,∗ , F. Bichat 1 , N. Baudoin 2 , Y. Béjot 4 , Y. Cottin 1 1 Service de cardiologie 2 Service de neuroradiologie, CHU Dijon-Bourgogne 3 PEC2, EA 7460, UFR Sciences de Santé, Université Bourgogne Franche-Comté 4 Service de Neurologie, CHU Dijon-Bourgogne, Dijon, France ∗ Corresponding author. Adresse e-mail : [email protected] (M. Zeller) Introduction Cerebral microbleeds (CMB) is a predictive factor of intracerebral haemorrhage (ICH) and patients with CMB under antithrombotics are at higher risk of ICH. Thus, the impact of anticoagulants and/or antiplatelets on the occurrence of ICH and/or on new CMB development is a major issue. Purpose We aimed to evaluate the early progression at 3 months of CMB and their predictive factors in patients with acute myocardial infarction (AMI) treated with direct oral anticoagulant (DOA) or vitamin K antagonist (VKA). Methods Prospective study from November 2016 to December 2018, including patients > 60 y hospitalized in intensive cardiac care unit for AMI. They underwent a first brain MRI (T2* gradient echo and SWI magnetic susceptibility image) < 72 hours after admission, and repeated 3 months after stenting. Results One hundred and eight patients (42 women and 66 men, mean age 77 years) were included. Among the patients with CMB (21%), 66 patients received a cerebral MRI at 3 months after AMI. An increase in CMB number was observed for 6% of patients. These patients were older than those without CMB progression (85 ± 5 vs. 75 ± 8 y, P = 0.016) and were more often treated by DOA or VKA at hospital discharge than patients with unchanged CMB number:OR = 15.6 [1.470—165.582]. In multivariate analysis, only